Healthcare Provider Details

I. General information

NPI: 1518267343
Provider Name (Legal Business Name): LYSETTE IGLESIAS, M.D, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 W 68TH ST SUITE 301
HIALEAH FL
33016-6889
US

IV. Provider business mailing address

8031 NW 169TH TER
MIAMI LAKES FL
33016-3430
US

V. Phone/Fax

Practice location:
  • Phone: 305-381-5301
  • Fax: 305-381-5541
Mailing address:
  • Phone: 305-639-0446
  • Fax: 305-381-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME 99374
License Number StateFL

VIII. Authorized Official

Name: DR. LYSETTE IGLESIAS
Title or Position: PEDIATRIC ENDOCRINOLOGIST
Credential: M.D
Phone: 305-639-0446